Experience and Resilience of Japanese Public Health Nurses during the COVID-19 Pandemic and Their Impact on Burnout
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Ethical Considerations
2.3. Instruments
2.3.1. Demographic Data
2.3.2. PHNs’ Experience during the COVID-19 Pandemic
2.3.3. Individual Resilience
2.3.4. Organizational Resilience
2.3.5. Burnout
2.4. Data Analysis
3. Results
3.1. General Demographics of the Participants
3.2. PHNs’ Experience and Organizational Resilience Perceived by PHNs
3.3. Association of PHNs’ Experience, Individual Resilience, and Organizational Resilience with Emotional Exhaustion
3.4. Association of PHNs’ Experience, Individual Resilience, and Organizational Resilience with Depersonalization
4. Discussion
4.1. Actual State of Individual Resilience and Burnout
4.2. Actual State of the PHNs’ Experience during the Pandemic
4.3. Relation of PHNs’ Experience, Resilience, and Organizational Resilience to Burnout
4.3.1. Relation of PHNs’ Experience, Resilience, Organizational Resilience to Emotional Exhaustion
4.3.2. Relation of PHNs’ Experience, Individual Resilience, Organizational Resilience to Depersonalization
4.4. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables (N) | Categories | n (%) or M ± SD | |
---|---|---|---|
Sex (N = 351) | Male | 32 | (9.1) |
Female | 318 | (90.6) | |
Other | 1 | (0.3) | |
Age (N = 349) | (M ± SD) | 39.21 ± 12.41 | |
20 s | 107 | (29.9) | |
30 s | 90 | (26.6) | |
40 s | 58 | (16.9) | |
≥50 s | 94 | (5.7) | |
Occupational position (N = 351) | Entry-level | 139 | (39.6) |
Mid-level | 113 | (32.2) | |
Administrative position | 99 | (28.2) | |
Career as PHN (N = 348) | <10 years | 180 | (51.7) |
10–<20 years | 60 | (17.2) | |
20–<30 years | 41 | (11.8) | |
≥30 years | 67 | (19.3) | |
Children below middle school (N = 349) | Yes | 72 | (20.6) |
No | 277 | (79.4) | |
Family member in need of nursing care (N = 350) | Yes | 20 | (5.7) |
No | 330 | (94.3) | |
Maximum overtime hours per month (N = 343) | <50 h | 66 | (19.2) |
50–<100 h | 130 | (37.9) | |
100–<150 h | 99 | (28.9) | |
≥150 h | 48 | (14.0) |
Variables | N | M ± SD | Range | |
---|---|---|---|---|
Potential | Actual | |||
Individual resilience (total) | 342 | 74.56 ± 10.22 | 21–105 | 37–101 |
Burnout | ||||
Emotional exhaustion | 350 | 3.36 ± 0.99 | 1.00–5.00 | 1.00–5.00 |
Depersonalization | 344 | 2.36 ± 0.89 | 1.00–5.00 | 1.00–5.00 |
Items | N | Strongly Agree | Agree | Neutral | Disagree | Strongly Disagree | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | ||
Experience I: Experience of complaints and verbal abuse from patients and community residents | |||||||||||
Complaints and verbal abuse from community residents about the PHC’s response | 351 | 215 | (61.3) | 110 | (31.3) | 15 | (4.3) | 9 | (2.6) | 2 | (0.6) |
Unreasonable demands or long hours of complaints from COVID-19-positive patients | 351 | 211 | (60.1) | 99 | (28.2) | 27 | (7.7) | 12 | (3.4) | 2 | (0.6) |
Experience II: Experience of weak infrastructural systems for conducting health activities | |||||||||||
Difficulty in gaining understanding of requests for cooperation in preventing the spread of infection from close contacts without a legal basis | 349 | 95 | (27.2) | 136 | (39.0) | 75 | (21.5) | 37 | (10.6) | 6 | (1.7) |
Inappropriate staff allocation from outside and within PHCs | 350 | 182 | (52.0) | 105 | (30.0) | 41 | (11.7) | 20 | (5.7) | 2 | (0.6) |
Lack of uniformity within the PHC (e.g., decisions on dealing with community residents, awareness of tasks, overall flow) | 349 | 106 | (30.4) | 124 | (35.5) | 67 | (19.2) | 44 | (12.6) | 8 | (2.3) |
Overtime/holiday work changes the life pattern | 350 | 259 | (74.0) | 68 | (19.4) | 15 | (4.3) | 6 | (1.7) | 2 | (0.6) |
Experience III: Hardship caused by widespread and prolonged spread of infection | |||||||||||
Difficulty in coordinating medical care for patients owing to lack of medical resources | 351 | 184 | (52.4) | 107 | (30.5) | 28 | (8.0) | 20 | (5.7) | 12 | (3.4) |
Without the concept of “full beds”, duties of dealing with patients are endless | 349 | 245 | (70.2) | 83 | (23.8) | 13 | (3.7) | 5 | (1.4) | 3 | (0.9) |
Difficulty in providing smooth health instructions to foreign community residents | 350 | 87 | (24.9) | 135 | (38.6) | 66 | (18.9) | 46 | (13.1) | 16 | (4.6) |
Being occupied with medical management for individuals, incapable of performing important duties for preventing infection spread | 351 | 154 | (43.9) | 121 | (34.5) | 47 | (13.4) | 23 | (6.6) | 6 | (1.7) |
Items | N | Strongly Agree | Agree | Neutral | Disagree | Strongly Disagree | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | ||
System Resilience | |||||||||||
There is a situation-specific response by the central government (e.g., establishing new departments, outsourcing of duties, dispatching staff) | 349 | 75 | (21.5) | 163 | (46.7) | 58 | (16.6) | 40 | (11.5) | 13 | (3.7) |
Support staff from outside of PHCs is kept fixed for the long-term and allows an accurate response to tasks | 348 | 26 | (7.5) | 124 | (35.6) | 89 | (25.6) | 87 | (25.0) | 22 | (6.3) |
In-office systems are constantly made and improved as necessary (e.g., developing tools for sharing information) | 348 | 38 | (10.9) | 151 | (43.4) | 79 | (22.7) | 57 | (16.4) | 23 | (6.6) |
A system for receiving support staff into PHCs is well prepared and coordinated as appropriate | 348 | 35 | (10.1) | 163 | (46.8) | 77 | (22.1) | 61 | (17.5) | 12 | (3.4) |
A shift in working styles in anticipation of long-term pandemics (e.g., introducing an overtime rotation system) | 348 | 40 | (11.5) | 88 | (25.3) | 93 | (26.7) | 73 | (21.0) | 54 | (15.5) |
Human Resilience | |||||||||||
Managers have leadership skills (e.g., quick decision-making, clear instructions, leading the response to difficult cases) | 349 | 93 | (26.6) | 148 | (42.4) | 65 | (18.6) | 34 | (9.7) | 9 | (2.6) |
There is a PHN who assists and supports the PHN manager | 349 | 76 | (21.8) | 151 | (43.3) | 69 | (19.8) | 43 | (12.3) | 10 | (2.9) |
Managers create a comfortable working environment. (e.g., culture of openness, careful attention to individual health) | 347 | 37 | (10.7) | 127 | (36.6) | 101 | (29.1) | 50 | (14.4) | 32 | (9.2) |
In responding to emergencies, the arrangement and management of work within the PHC organization are reviewed | 349 | 58 | (16.6) | 149 | (42.7) | 62 | (17.8) | 57 | (16.3) | 23 | (6.6) |
Feeling free to share conflicts and personal feelings within the organization | 348 | 53 | (15.2) | 125 | (35.9) | 85 | (24.4) | 59 | (17.0) | 26 | (7.5) |
There is a sense of awareness and common understanding of the disaster response to be undertaken by all staff at PHCs | 348 | 31 | (8.9) | 115 | (33.0) | 104 | (29.9) | 67 | (19.3) | 31 | (8.9) |
Entry-Level | Mid-Level | Administrative Position | H 1 (p) | ||||
---|---|---|---|---|---|---|---|
n | M ± SD | n | M ± SD | n | M ± SD | ||
Experience (total) | 136 | 41.68 ± 5.44 | 112 | 43.23 ± 4.94 | 95 | 41.35 ± 5.87 | 7.61 (0.022) A |
I. Experience of complaints and verbal abuse from patients and community residents | 139 | 8.97 ± 1.39 | 113 | 9.12 ± 1.43 | 99 | 8.70 ± 1.61 | 5.03 (0.081) |
II. Experience of weak infrastructural systems for conducting health activities | 137 | 16.17 ± 2.87 | 113 | 17.11 ± 2.16 | 95 | 16.25 ± 2.63 | 6.87 (0.032) |
III. Hardship caused by widespread and prolonged spread of infection | 138 | 16.55 ± 2.47 | 112 | 16.99 ± 2.61 | 98 | 16.38 ± 2.98 | 3.94 (0.139) |
Organizational resilience (total) | 136 | 38.65 ± 7.00 | 113 | 35.06 ± 8.64 | 96 | 37.83 ± 8.56 | 11.93 (0.003) B,C |
System resilience | 136 | 17.04 ± 3.88 | 113 | 15.57 ± 4.57 | 98 | 17.08 ± 4.11 | 8.43 (0.015) B |
Human resilience | 136 | 21.61 ± 4.15 | 113 | 19.50 ± 4.90 | 97 | 20.76 ± 5.15 | 13.22 (0.001) B |
Variables 1 | Regression Coefficient | Model 1 | Model 2 | Model 1 | Model 2 | |||||
---|---|---|---|---|---|---|---|---|---|---|
β | p | β | p | β | p | β | p | Β | p | |
Control | ||||||||||
Sex (Female = 1) | −0.010 | 0.854 | 0.025 | 0.611 | 0.014 | 0.768 | 0.050 | 0.324 | 0.037 | 0.458 |
Children below middle school | −0.087 | 0.104 | −0.149 | 0.006 | −0.147 | 0.006 | −0.161 | 0.004 | −0.160 | 0.003 |
Family member in need of nursing care | −0.084 | 0.115 | −0.078 | 0.115 | −0.072 | 0.144 | −0.081 | 0.110 | −0.075 | 0.134 |
Maximum overtime hours | 0.016 | 0.764 | −0.001 | 0.979 | −0.006 | 0.906 | 0.011 | 0.839 | 0.002 | 0.966 |
Occupational Position (mid-level as reference) | ||||||||||
Entry-level | 0.038 | 0.478 | −0.039 | 0.526 | −0.016 | 0.788 | −0.068 | 0.274 | −0.037 | 0.540 |
Administrative position | −0.135 | 0.011 | −0.111 | 0.080 | −0.110 | 0.078 | −0.131 | 0.043 | −0.127 | 0.045 |
PHNs’ experience | ||||||||||
II. Experience of weak infrastructural systems for conducting health activities | 0.335 | <0.001 | 0.300 | <0.001 | 0.279 | <0.001 | - | - | - | - |
III. Hardship caused by widespread and prolonged spread of infection | 0.215 | <0.001 | - | - | - | - | 0.212 | <0.001 | 0.219 | <0.001 |
Individual resilience | −0.278 | <0.001 | −0.220 | <0.001 | −0.199 | <0.001 | −0.242 | <0.001 | −0.213 | <0.001 |
Organizational resilience | ||||||||||
System resilience | −0.157 | 0.003 | −0.041 | 0.420 | 0.086 | 0.166 | −0.096 | 0.061 | 0.068 | 0.277 |
Human resilience | −0.276 | <0.001 | - | - | −0.220 | 0.001 | - | - | −0.271 | <0.001 |
R2 | 0.201 | <0.001 | 0.229 | <0.001 | 0.163 | <0.001 | 0.206 | <0.001 | ||
ΔR2 | 0.028 | <0.001 | 0.043 | <0.001 |
Variables | Regression Coefficient | Model 1 | Model 2 | Model 1 | Model 2 | |||||
---|---|---|---|---|---|---|---|---|---|---|
β | p | β | p | β | p | β | p | β | p | |
Control | ||||||||||
Sex (Female = 1) | −0.129 | 0.016 | −0.087 | 0.074 | −0.102 | 0.032 | −0.066 | 0.194 | −0.084 | 0.090 |
Children below middle school | −0.035 | 0.516 | −0.103 | 0.051 | −0.101 | 0.050 | −0.108 | 0.053 | −0.107 | 0.044 |
Family member in need of nursing care | −0.019 | 0.725 | 0.009 | 0.852 | 0.018 | 0.699 | 0.011 | 0.836 | 0.019 | 0.692 |
Maximum overtime hours | 0.018 | 0.741 | 0.017 | 0.735 | 0.011 | 0.824 | 0.035 | 0.509 | 0.024 | 0.637 |
Occupational Position (mid-level as reference) | ||||||||||
Entry-level | 0.060 | 0.266 | −0.038 | 0.526 | −0.008 | 0.897 | −0.071 | 0.258 | −0.031 | 0.605 |
Administrative position | −0.205 | <0.001 | −0.171 | 0.006 | −0.170 | 0.005 | −0.196 | 0.003 | −0.190 | 0.002 |
PHNs’ experience | ||||||||||
II Experience of weak infrastructural systems for conducting health activities | 0.356 | <0.001 | 0.321 | <0.001 | 0.292 | <0.001 | - | - | - | - |
III Hardship caused by widespread and prolonged spread of infection | 0.184 | <0.001 | - | - | - | - | 0.156 | 0.002 | 0.166 | 0.001 |
Individual resilience | −0.295 | <0.001 | −0.223 | <0.001 | −0.194 | <0.001 | −0.248 | <0.001 | −0.211 | <0.001 |
Organizational resilience | ||||||||||
System resilience | −0.136 | 0.011 | −0.006 | 0.910 | 0.167 | 0.006 | −0.069 | 0.175 | 0.142 | 0.023 |
Human resilience | −0.302 | <0.001 | - | - | −0.298 | <0.001 | - | - | −0.349 | <0.001 |
R2 | 0.229 | <0.001 | 0.279 | <0.001 | 0.160 | <0.001 | 0.230 | <0.001 | ||
ΔR2 | 0.051 | <0.001 | 0.070 | <0.001 |
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Miyazaki, A.; Sankai, T.; Omiya, T. Experience and Resilience of Japanese Public Health Nurses during the COVID-19 Pandemic and Their Impact on Burnout. Healthcare 2023, 11, 1114. https://doi.org/10.3390/healthcare11081114
Miyazaki A, Sankai T, Omiya T. Experience and Resilience of Japanese Public Health Nurses during the COVID-19 Pandemic and Their Impact on Burnout. Healthcare. 2023; 11(8):1114. https://doi.org/10.3390/healthcare11081114
Chicago/Turabian StyleMiyazaki, Akari, Tomoko Sankai, and Tomoko Omiya. 2023. "Experience and Resilience of Japanese Public Health Nurses during the COVID-19 Pandemic and Their Impact on Burnout" Healthcare 11, no. 8: 1114. https://doi.org/10.3390/healthcare11081114